Revision TKR Never give up, keep trying, don't settle - that's me, Bonnie

[RunA42K]

maryo52, his name is Dr. Stephen Incavo, look him up here in Houston. Just google him. He told me about the ligaments before hand, and after surgery he confirmed to my husband that the ligaments needed to be balanced and shortened. Thus holding my knee in place. He will never say anything bad about another doctors work, I would not expect him to, but was adamant that with the knee he gave me there would be no more worry of scar tissue. Swelling and pain is incredibly less than before.

 

[maryo52]

I'm happy for you, less happy for me. I try not to think about how my knee turned out. At some point you have to cut your losses and learn to be happy with what you've got. On the other hand, when I hear that ligaments can be shortened - ?? - during TKR, I start entertaining the idea of revision again. How were your ligaments balanced? I have tremendous lateral laxity. My knee can bend sideways toward the other knee quite a bit. Yeah, and I'm pretty sure that even with a brace, this feeds the inflammation.

 

[Orthodoc]

Would it have any bruising at all, because there is none

Yes, as a hematoma tracks down (or even up - if elevated) a leg then bruising would be seen. However, swelling can come from a simple process called third spacing. This is when the fluid gets "stuck" in the soft tissues and is not cleared back to the heart using the normal veins or lymphatic systems. In this situation, the swelling can be painful but without bruising. This is very common after trauma or surgery.

Orthodoc

 

[RunA42K]

maryo52 Mary that is what he found my knee to be doing during my first exam with him. He took a long time moving my leg in all kinds of directions from the knee. Yes indeed he said that my knee was moving sideways, calling it sloppy, and talking about ligament instability. It made so much sense, because from 8 week post op from my first TKR I started in with pain on the side of my knee, side closest to my left knee. It put me back on pain pills. Then I had about a month of patches with Dexamethasone (the drug in cortisone shots)they would infuse in through my skin. Eventually my OS gave me a cortisone shot it didn't help. Right up until the day I went in for my revision the same area of my knee that I described had ALWAYS felt bruised inside, 2 years and 8 months. I never did 'not hurt there'. Evidently causing inflammation that your body sends out scar tissue to heal itself. It made so much sense and no wonder my recovery was so hard back then. My knee was fighting itself the entire time. A couple pages back on my thread, 'Orthodoc' was explaining the instability in the ligaments which was very helpful. At the end of the day I had to make the choice for revision, because I could not choose to live my life the was I was. It was a VERY good decision, and recovery is no where near as bad as before. I'd look into it if I were you.

 

[Oldie]

Bonnie, isn't it amazing how these revision surgeons can find the reason for the pain so easily! The original OS's never see anything wrong or maybe its their Ego that doesn't let them admit they did anything wrong.
So happy you are doing so well. Continue taking it easy, don' t overdue the exercises And you will be ready form PT in a couple weeks.

 

[skigirl]

maryo52, I also have a much more stable knee after the spacer exchange---and the scar tissue has not returned. I think you should look into it too!

 

[RunA42K]

Oldie I think that you hit the nail on the head. The original OS's probably blind to any dysfunction or pain because their egos are in the way!

So I am at day 12. I had a pretty crummy time sleeping last nigh. Just never could get comfortable, leg was aching. Between 9 pm and 6 am I ended up taking 3 pain pills total. I never felt like they were working. I got up about 7:30 am with a headache and nausea. I took one of my anti nausea pills.

Maybe I was uncomfortable because I did my exercises, two sets yesterday. I am wondering, if you 'resters' after TKR with no formal Physical Therapy, did you do your exercises every day? Did you do them every other day? I am just wondering if three days in a row was too much?

 

[Pumpkin]

Bonnie,
I think you are doing way too much. Split your exercises up, half one day, half the next day. And take one or two days a week off. You are still in the less is more phase of your recovery.

BTW when I saw my original OS after consulting with 3 revisionists last year, you should have seen the look the OS's face. He hurried out looked at the x ray, and came back and explained why he used the larger implant.
Why, because it was going to rest over softer cancellous bone and might sink into the bone.:rolleyes:

 

[skigirl]

Bonnie---I hardly ever did any exercises at home. i went to outpatient pt 3 times a week and they used to have me do heel slides, leg lifts, glute lifts, etc--but with the revision, I did very few weight bearing exercises as it made my leg ache and we did not want to inflame the knee and increase the chances of the scar tissue returning.

 

[Oldie]

Yes I agree with the others, maybe you are doing too much. Don't know what is in your set of exercises, but I only did the heel slides,quad seta and a few stretches only a few times a day. If it hurts, stop for a day or so and ice & elevate, you'll be fine. Wait till you go to PT to do all those exercises it will be worth it.

 

[Celle]

It's 2 years ago now, so I might not remember perfectly, but I don't think I ever did a set series of exercises. Once I was able to get myself out of bed and walk to the bathroom and kitchen, I stopped doing heel slides in bed.

I'd do a few ankle pumps now and then (when I remembered) and lifting my leg up onto the bed took care of the straight leg raises, but I think that walking took took the place of most of the rest of the exercises. I'd make a point of walking up and down the hall a few times, every time I got out of bed, always thinking "Heel, toe, push off"; as the days went by, I increased the distance I walked, having a tour of the garden and then up the driveway etc. I'm sure I've read somewhere on BoneSmart that walking is the best exercise of all. It worked for me, anyway.

For bending, I'd try to move my foot further back every time I sat on a chair. We have a couple of steps in our garden - no stairs in the house - so I'd go up and down those steps a few times a day.

I think PTs would despair of me if they ever saw/knew how very little formal exercise I did!

 

[kneeper]

Hang in there Bonnie--I hope this one does the trick for you.

 

[RunA42K]

I thought I was having a pretty good day yesterday. I spent most of the day out in the living room/family room/great room (whatever you all call it). I sat in a chair, feet propped up on an ottoman, pillow underneath my feet. I iced off and on different areas of my leg as I am still having ankle pain, maybe it's not the ankle at all. It is right where the tibia meets the foot right in the front middle of my leg and foot. I still have that achey-ness in the one spot of my calf (surgery leg). Sometimes I'd sit for a bit with knees at 90 degrees with feet on the floor. I'd get up and walk around with one crutch periodically. I'd not had any pain pills all day.

Then...when it came time to go to bed, by then my whole calf was aching all over, knee was aching, ankle area hurting. I went to bed with an ice pack, I was tired and fully expected to sleep. Once I got into bed and was still, it was like every pain was magnified. I decided to take a pain pill. Then I decided I would take two pain pills instead of one because I was so uncomfortable. Of course you wait an hour for the pain pills to start working...then 2 hours, nothing, 3 hours, 4 hours, so since it had been 4 hours I took one more pain pill. While everything else eventually settled down except my knee/tibia, I felt like I was awake all night. I was aware that from the knee, down to the mid tibia I just had a deep ache. Would not go away, I tossed and turned all night long trying to get comfortable, but no luck. I got up this morning with the ache in my tibia.

After I let the dogs out, fed them, made myself some coffee, I came back to the bed, took one pain pill and here I sit with ice pack on the knee to mid tibia. I don't know what I did wrong yesterday. Yes I might have been on my feet slightly more than usual, but I was sitting for so much of the day in front of the TV with iPad on my lap. Today I am two weeks post op. I am doing amazingly well compared to my original TKR, maybe because of that I forget how fresh my surgery is??? Good days, bad days, I guess I am not out of the woods yet.

 

[Pumpkin]

Bonnie,
Your surgery was only two weeks ago, you have a few months to go before you can even think about being out of the woods.
By not taking any pain meds during the day, your pain got ahead of you, you still need to medicate on schedule! During the day you may not notice it as much, but it is there. As you found out your pain was magnified at night, and you had to take even more medication to control your pain.
Write the Mantra down somewhere you can see it to remind you. Rest, Ice, Elevate, and Medicate on Schedule.
Also, remember, "Just Because You Can, Does Not Mean You Should".
What did you do wrong yesterday? You did too much, and you did not medicate on schedule.
Sorry for the lecture, but it needed to be said.
SLOW DOWN!

 

[RunA42K]

@Pumpkln ...thank you for the lecture. Sometimes I need a wake up call. Because I am feeling better I have to remind myself when my surgery was and not feel guilty that I should be doing more. As far as the pain medication goes, I think I am freaked out about my surgeons strict guidelines on pain medication. I feel like if I don't hurt, don't take any because after one month he will not refill. I figure when I start Physical Therapy I will need it then. I'm going to see if I can get a refill approved on Dec. 20, that way if I need to maybe he will refill one more time when my one month arrives.

 

[Pumpkin]

Bonnie,
Go to your GP for pain medication.
If I have a revision I already talked to my primary about taking over my pain meds, she said she would be happy to help.

 

[RunA42K]

Bonnie,
Go to your GP for pain medication.
If I have a revision I already talked to my primary about taking over my pain meds, she said she would be happy to help.

@Pumpkln , I will do that. I've been with my GP long before I'd ever had my first TKR. So she's followed me through 4 surgeries now and through my husband's illness. We have a very good relationship.

 

[kneeper]

Maybe if you maintain at least some pain meds during the day you can stretch them out a bit and keep the pain from getting a hold on you. But yes, your GP should also be able to help.

 

[RunA42K]

@Orthodoc @Josephine @maryo52 @skigirl
Do you think that this could happen, do you think it makes any sense?

My gait for most of adult life (that I am aware of) I've had a gait where my right foot turned outwards. I never really noticed it or thought twice about it until I was running a lot and every picture taken of me running you could see the right foot turned outwards, left foot always straight. The same when I would pedal a bicycle, right foot pointing out to side from the pedal. In PT for the very first time in 2010 it was very noticeable to my PT and he was always telling me to put my foot straight. I didn't even know I was doing it and he'd bring it to my attention. When I would put my right foot straight alongside my left foot, I would feel like I was standing pigeon toed with the right foot, but looking straight down, both feet were straight right in front of me. My PT said that there was a name for it, called Tibial Torsion where the femur when it attaches to the tibia just turns a bit to much to the right. After my first TKR my foot still turned out the same way so through all of hat PT I was told to straighten out my foot. Any type of squatting/stooping with a bent right leg would make my knee roll inward to the medial side. During the motion of running my knee would dip to the inside with impact on the right foot. This is where the pain was for all of the 2 years and 8 months after the original TKR. That is where I was bone on bone.

Now, this is the question…I have noticed that since my revision my foot does NOT turn out any longer when I walk. I look down and it is straight just like my left. My ankle and foot have been sore ever since I started walking with this revision. I wonder if it is possible that the doctor straightened my gait (tibia torsion) when he gave me my new knee? I wonder if my ankle/foot is sore because I am walking and putting pressure on muscles, tendons and the little bones in my foot that different from how I used to walk? I wondered if over the years that my foot turning outwards could have contributed to me wearing out the cartilage and arthritis, leading to all my knee problems?

I'll see him Friday so I guess I can ask him about that. I just think how astute of him to make my leg straight after all this time and the other OS never mentioning a thing about it, or maybe not even noticing?

 

[Orthodoc]

My ankle and foot have been sore ever since I started walking with this revision. I wonder if it is possible that the doctor straightened my gait (tibia torsion) when he gave me my new knee?

The rotation of the leg is dependent on how the components are positioned. Remember that the leg will follow however the new knee is implanted. The issue you are describing is more influenced by how the tibial component is positioned. Specifically, the tibial component can be rotated inward or outward or placed perfectly straight. In general most knee replacements will realign the leg (to make the leg appear rotationally straight) when the middle of the tibial component is placed over the medial 1/3 of the tibial tubercle (the bone that sticks out just underneath the patella tendon). However, this may need to be adjust from time to time depending on the patient. The use of rotating platform knees have an increased freedom to allow for motion in this plane and are more forgiving of slight mal-rotation during implantation.

Orthodoc